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- W4387255575 abstract "SESSION TITLE: Pulmonary Manifestations of Systemic Disease Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Systemic lupus erythematosus (SLE) is an autoimmune disease signified by multi-organ manifestations, including pleuropulmonary involvement. Diffuse alveolar hemorrhage (DAH) is a syndrome characterized by bleeding into the alveolar spaces of the lungs and a potentially fatal condition associated with SLE with an average mortality rate of 50%. Here, we present a case of a patient with SLE in which empiric plasmapheresis was given in view of high clinical suspicion. CASE PRESENTATION: A 22-year-old female with a medical history of Lupus Nephritis Type IV refractory to treatment with Mycophenolate Mofetil was admitted with lupus nephritis exacerbation with nephrotic range proteinuria. She was started on cyclophosphamide and high-dose glucocorticoids. Hospitalization was complicated with anuric renal failure, associated volume overload, and hypoxemic respiratory failure requiring emergent hemodialysis and mechanical ventilation. Two weeks after admission, the patient developed hemoptysis, increased oxygen requirement, and an acute decrease of two grams of hemoglobin. Chest X-ray showed bilateral pulmonary infiltrates. Chest CT revealed scattered ground-glass opacities throughout the bilateral upper lobes, with a centrally predominant distribution and peribronchovascular consolidations. The patient was started on empiric IV antibiotics due to the possibility of infectious pneumonia, but clinical findings were concerning for DAH. Pneumology service was consulted for diagnostic bronchoscopy. However, the procedure was delayed due to clinical instability, severe thrombocytopenia, and no availability of plateletpheresis. Due to high clinical suspicion, a multidisciplinary decision was made to give empiric therapeutic plasma exchange. She was managed with Methylprednisolone 1,000 mg/day for three days and plasma exchange for seven days, after which oxygen requirement improved, and no recurrence of bleeding has been reported. Diagnostic bronchoscopy was performed two weeks later. DISCUSSION: DAH is a life-threatening medical emergency characterized by hemoptysis, anemia, hypoxemic respiratory failure, and diffuse alveolar infiltrates. A combination of physical examination, radiographic analysis, and laboratory tests can help to establish the diagnosis. In addition, early bronchoscopy is usually required to confirm the diagnosis and rule out infection. In our case, due to severe thrombocytopenia and lack of plateletpheresis availability, diagnostic bronchoscopy could not be performed, for which a multidisciplinary decision was made to give a trial of plasmapheresis with significant improvement in the patient's condition. CONCLUSIONS: Our case serves as an example that in the setting of a national blood product shortage or a contraindication of bronchoscopy, a consideration of empiric plasmapheresis could be made if the diagnostic procedure would delay early treatment of this morbid and mortal condition. REFERENCE #1: Kazzaz NM, Coit P, Lewis EE, McCune WJ, Sawalha AH, Knight JS. Systemic lupus erythematosus complicated by diffuse alveolar haemorrhage: risk factors, therapy and survival. Lupus Sci Med. 2015 Sep 23;2(1):e000117. doi: 10.1136/lupus-2015-000117. PMID: 26430514; PMCID: PMC4586940. REFERENCE #2: Al-Adhoubi NK, Bystrom J. Systemic lupus erythematosus and diffuse alveolar hemorrhage, etiology and novel treatment strategies. Lupus. 2020 Apr;29(4):355-363. doi: 10.1177/0961203320903798. Epub 2020 Feb 9. PMID: 32036761; PMCID: PMC7436451. DISCLOSURES: No relevant relationships by Tania Aguila No relevant relationships by Victor Ivan Mendoza Cruz No relevant relationships by Gabriela Negron-Ocasio No relevant relationships by Maria Pestaña-Rodriguez No relevant relationships by Gretchen Rios Grant No relevant relationships by Verónica Torres-Torres No relevant relationships by Mark Vergara-Gomez" @default.
- W4387255575 created "2023-10-03" @default.
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- W4387255575 date "2023-10-01" @default.
- W4387255575 modified "2023-10-03" @default.
- W4387255575 title "THE CLOCK IS TICKING: EARLY RECOGNITION AND MANAGEMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS-ASSOCIATED DIFFUSE ALVEOLAR HEMORRHAGE" @default.
- W4387255575 doi "https://doi.org/10.1016/j.chest.2023.07.3705" @default.
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